Active NPI
Seoung Sou Park, MD
- Endocrinology, Diabetes & Metabolism Physician
- Mount Vernon, NY
National Provider Identifier
1902948193
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endocrinology, Diabetes & Metabolism Physician
- License
- 197192
- Practice address
- 105 Stevens Avenue
Suite 310
Mount Vernon, NY 10550-2686 - Phone
- (914) 663-6635
- Fax
- (914) 663-6637
- NPI assigned
- Feb 13, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endocrinology, Diabetes & Metabolism Physician | 207RE0101X | 197192 | NY | Primary |
Addresses
Primary practice location
105 Stevens Avenue
Suite 310
Mount Vernon, NY 10550-2686
Mailing address
105 Stevens Avenue
Suite 310
Mount Vernon, NY 10550-2686
Phone (914) 663-6635
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 21N461 | Other | NY | EMPIRE BCBS |
| P1229667 | Other | OXFORD HEALTH PLAN | |
| 01729675 | Medicaid | NY | |
| 7464117 | Other | AETNA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 197192 | NY | MD | Endocrinology, Diabetes & Metabolism Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1902948193",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 STEVENS AVENUE",
"address_2": "SUITE 310",
"city": "MOUNT VERNON",
"state": "NY",
"postal_code": "105502686",
"telephone_number": "914-663-6635",
"fax_number": "914-663-6637"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 STEVENS AVENUE",
"address_2": "SUITE 310",
"city": "MOUNT VERNON",
"state": "NY",
"postal_code": "105502686",
"telephone_number": "914-663-6635",
"fax_number": "914-663-6637"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "SEOUNG",
"middle_name": "SOU",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207RE0101X",
"taxonomy_group": "",
"desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
"state": "NY",
"license": "197192",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EMPIRE BCBS",
"identifier": "21N461",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD HEALTH PLAN",
"identifier": "P1229667",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01729675",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7464117",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Mount Vernon, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.